Hyperprogressive disease after treatment with pembrolizumab in lung adenocarcinoma: An autopsy case study.

在肺腺癌中使用 pembrolizumab 治疗后的高进行性疾病 ： 尸检病例研究。

• 发表时间: 2019
• 来源期刊: Respir Med Case Rep
• DOI: 10.1016/j.rmcr.2019.100885
• PMID: 31249779
• 文章类型: Case Reports
• 作者列表: Tanaka Y,Matsubara O,Asada K,Muramatsu A,Suzuki M,Shirai T

关键词: ALK, anaplastic lymphoma kinase; DIC, Disseminated intravascular coagulation; DVT, deep vein thrombosis; EBUS-TBNA, Endobronchial ultrasound-transbronchial needle aspiration; ECOG, Eastern Cooperative Oncology Group; EGFR, epidermal growth factor receptor; HPD, hyperprogressive disease; HRCT, high-resolution computed tomography; Hyperprogressive disease; ILD, Interstitial lung disease; Immune checkpoint inhibitors; NSCLC, non-small cell lung cancer; Non-small cell lung cancer; PD-L1; PD-L1, Programmed cell death ligand 1

Abstract

Although immune-checkpoint inhibitors (ICIs) have become an important choice of treatment for advanced NSCLC, recent reports show hyperprogressive disease (HPD) after ICI administration. The clinico-pathological features of HPD still remain unclear. Here we report a 65-year-old man with lung adenocarcinoma who abruptly presented HPD two days after pembrolizumab administration. The primary tumor increased in size from 40 mm to 57 mm on the chest HRCT. The patient died on day 37 after pembrolizumab administration. The autopsy demonstrated widespread progression of cancer cells into the alveolar spaces and lymphangitic carcinomatosis in the left lung, with plenty of bloody pleural effusion. We compared the pathohistology and immunohistochemical expression of PD-L1 between the pretreatment biopsy material and posttreatment autopsy materials, and found a change in PD-L1 expression which may be related to HPD. We also discuss the possibility of HPD, pseudoprogression, and interstitial lung disease when there is evidence of tumor growth or ground glass shadows on chest images after ICI treatment.

摘要

尽管免疫检查点抑制剂（ICIs）已成为晚期NSCLC的重要治疗选择。最近的报告显示ICI给药后的高进行性疾病（HPD）。HPD的临床病理特征仍不清楚。在这里，我们报告了一名65岁的肺腺癌患者，他在pembrolizumab给药后两天突然出现HPD。在胸部HRCT上，原发性肿瘤的大小从40毫米增加到57毫米。患者在给予派姆单抗后第37天死亡。尸检显示癌细胞广泛进展到左肺的肺泡腔和淋巴管癌病，有大量血腥的胸腔积液.我们比较了预处理活检材料和治疗后尸检材料之间PD-L1的病理组织学和免疫组织化学表达，并发现PD-L1表达的变化可能与HPD有关。我们还讨论了HPD的可能性，伪进程，当ICI治疗后胸部图像上有肿瘤生长或磨砂玻璃阴影的证据时，以及间质性肺病。